Health Care Act Reminds Young Adults They're Not Invincible

This is TELL ME MORE from NPR News. I'm Michel Martin. Coming up, you've probably heard a lot about the Stand Your Ground law in the death of Trayvon Martin, but you might not have heard about the woman who said she just fired a warning shot at her abusive husband and was sentenced to 20 years in prison. Now her case is getting a second look, and we'll talk about that in just a few minutes.

First, we're going to talk about healthcare. The online marketplace for health insurance under the Affordable Care Act went live on Tuesday, and despite glitches, the Department of Health and Human Services estimates that 2.8 million Americans visited the federal site healthcare.gov. We wanted to take a look at how the law and especially health exchanges might affect young adults, especially the millions without health insurance right now. Now they're sometimes called invincibles because, supposedly, being young and healthy, they think they are and don't need coverage. But we wondered if that's really what's keeping them from getting insurance and if the Affordable Care Act might change that. So we've called Jenny Gold to talk about that. She's a correspondent at Kaiser Health News. That's a nonprofit news organization. It's not affiliated with Kaiser Permanente. And she's with us now. Jenny Gold, welcome. Thanks so much for joining us.

JENNY GOLD: Thanks for having me.

MARTIN: Now your organization estimates that 27 percent of young adults lack health coverage. Tell us a bit more about who these young uninsured people are.

GOLD: So that's about 19 million young adults who are expected to gain coverage under the Affordable Care Act. We know some things about them. We know they tend to be mostly male and nonwhite. And we know about a third of them live in just three states - California, Texas and Florida.

MARTIN: That's interesting. Now we headed to Facebook to find out more about these millennials or young invicibles, as they're sometimes called. We heard from 25-year-old Jason Santiago (ph). He said he's not covered by his employer and that the law is already helping him.

He said, quote, the Affordable Care Act made it possible for me to remain under my mother's insurance plan up until age 26. Ironically, I was diagnosed with testicular cancer, no doubt with testing, payments, imaging, surgery, follow-up treatment, etc., that would be extremely expensive without insurance. Jason said he's very glad that he was diagnosed now rather than after he turned 26 because he actually had not planned on signing up for insurance, and now he's changed his mind. To that end, the theory is that these young adults just think they don't need insurance, but do you think that there's another factor?

GOLD: Absolutely. I mean, certainly, there are some people who, like this young man, maybe thought they didn't need it until it turned out they really did. But it turns out that three-quarters of young adults - according to a recent Kaiser Family Foundation plan - actually would sign up if they had access to it. The reason they list the top reason as why they don't have it is that it's not affordable. One of the reasons so many young people are uninsured is because they don't have a lot of money. They tend to be poor and a lot of them right now in the recession are unemployed.

MARTIN: Why young men and why young men of color in particular?

GOLD: I mean, I think it's the same sort of poverty kind of indicators that we're seeing that are also why those particular demographic groups maybe don't have coverage. They simply can't afford it, and they're not getting it through an employer.

MARTIN: You wrote an article about how Latinos could play a big part in whether the health exchanges work. Tell us a bit more about that.

GOLD: Absolutely. Latinos are one of the key demographics and you know what? The White House totally knows it. Latinos make up about 17 percent of the population, but they're 23 percent of the uninsured, and nearly half of them are under the age of 26. So that makes them the perfect key demographic - those young and healthy people that the White House needs to sign up for the Affordable Care Act. Now, there's been a lot of outreach efforts to target Latinos in particular.

A huge proportion of them actually watch one particular television network called Univision, which in July was the number one network over ABC, CBS, NBC, and the majority of Hispanic households watch that. So by advertising through Univision, insures and the government can really reach a very wide swath of the population. But advocates have complained that there isn't enough money to reach Latinos. They've said that healthcare.gov - that's the federal government's website for Obamacare - they've complained that the Spanish version isn't culturally competent. And most recently, they said that online enrollment through the Latino site, cuidado de salud, has been delayed until October 21.

MARTIN: Why?

GOLD: I think they just said, well, Spanish-language sites are often delayed and this one just happened to have some kinks we had to work out. They didn't give a large explanation. Although, they did say they were delaying it to coincide with Hispanic Heritage Month, but that was a little problematic because Hispanic Heritage Month actually ends on October 15.

MARTIN: It does. If you're just joining us, we're talking about uninsured millennials, the so-called young invincibles. We're speaking with Kaiser Health News correspondent Jenny Gold who's been following this particular demographic. As we mentioned, we've been reaching out on Facebook to hear the experiences of people who are in our listening audience. We heard from Kevin Drew (ph). He's a 33-year-old music teacher in Des Moines, Iowa. He's currently uninsured. This is what he told us.

KEVIN DREW: I hadn't bought my own health insurance. I was kind of new. I should've, but I never got around to it just because I felt healthy and I also couldn't afford a private healthcare plan. I had done some shopping for individual health care on the private market before and everything was just a little bit out of my price range. So I'm hoping that the new exchanges will bring down the costs so I can afford it.

MARTIN: So what about that? Is there any evidence that that's occurring?

GOLD: Well, young people actually have several options. For Kevin, he's going to be in the exchange just like anyone else. When he goes into the exchange now, it's possible he might see his rates go up. But one thing that's really important to remember is that even though the rates might appear higher, what you're getting may be a lot - a much richer set of benefits. It's important to compare apples to apples. And in addition, if Kevin makes under four times the federal poverty level - that's about $46,000 a year - if he's single, he is eligible for some sort of subsidy to help him pay for that private coverage on the exchange.

MARTIN: You know what's interesting, I think it's well understood that there's a need for young healthy adults like Kevin to participate in the plan so that the exchanges will be financially solvent. And we also understand that this is a very connected generation, that these are people who have access to lots of streams of information. But a recent Gallup poll found that young adults were the least knowledgeable about key aspects of the law. And I want to know why you think that is. And you mentioned that the White House is doing specific outreach to Latinos. Are they doing specific outreach to these groups, or if not the White House, then who? Is somebody trying, specifically, to convince these people in this demographic to participate?

GOLD: They don't know now, but I have a feeling they're going to know. Not only through outreach from the state exchanges and the White House, but also from insurers, from hospitals, from pharmacies. Everybody wants these young people to get in the pool. In particular, the insurers really have a major incentive. You're going to see a lot of direct-to-consumer advertising from insurers to young people. Those are the people they need to get in because they have lower health care costs. They're the ideal demographic for an insurer.

MARTIN: Many people might have seen that there have been some ads posted on YouTube, I believe it is, directed at this group, urging them not to participate and suggesting that this is not a good thing. Could you tell us a little bit more about that?

GOLD: So you're seeing some pretty creepy ads coming out from the anti-Obamacare people that involve Uncle Sam popping up in inopportune moments during somewhat embarrassing medical exams. And I think those really are targeted to young people. They're young people who are getting the exams in the advertisements and at the end it says, opt-out of Obamacare. And if the anti-Obamacare folks can get the young people to really opt-out, then, yeah, the premiums really will be higher and the law might fall apart.

MARTIN: What's the intention of those ads? The ads are very visual. So you're talking about creepiness, it's like a big kind of Uncle Sam, like one of those mascots that you might see at a baseball game with a huge head and so forth. So - with ominous music.

GOLD: They pop up in a gynecological exam.

MARTIN: Yeah.

GOLD: The perfect time you don't want someone in the room with you.

MARTIN: Yeah.

GOLD: And that's the idea that young people and all Americans shouldn't want the government to be involved in their medical care.

MARTIN: It's interesting, though, that those ads seem to be aimed at a group that is not primarily the one that is the most likely to be uninsured, which you say are young men of color.

GOLD: Well, I think that's the majority, but they may be trying to target people they think are more amenable to their perspective.

MARTIN: So is there an effort to counter those ads, which have gotten a lot of attention in the media particularly?

GOLD: Absolutely. A lot of the ads you're seeing coming out from state exchanges are really targeting young people. There's one out of Washington state that features a snowboarder who's getting in a boarding accident. It's a very young person. And those are supposed to appeal to people who think they're young invincible but never know when they might, in their extreme sports, have an accident. You've also got Jennifer Hudson recently on Funny or Die being a spokesperson for the Affordable Care Act. She's a hero for a lot of young people.

MARTIN: And finally, a lot of the messages we received took issue with the phrase, young invincibles - kind of looping back to where we started our conversation. A lot of people told us that they're not uninsured because they think they're invincible, they say they're not insured because they don't have the money - looping back to your original point. Here's Stasha Switzer. She's 26-years old. She's an organic farmer in Minnesota, and she told us she's also uninsured.

STASHA SWITZER: My career is not very lucrative. And me and other people like me are kind of in this weird position of now being forced to buy something that we still can't afford. Hopefully, next year it will be different, but this year I do plan to opt-out and pay the tax for not having healthcare.

MARTIN: So what about that? I mean, there has been a lot of anger over this particular issue of a penalty or a tax for people who do not opt-in.

GOLD: In the first year, the penalty is $95 or 1 percent of income, but that fee rises to nearly $700 or 2.5 percent of income in 2016. So while the mental math may make sense to skip it in the first year, going forward, it may not make as much sense. Now she's young, she doesn't make a lot of money. Chances are, she's going to qualify for some sort of subsidy to help her buy on the exchange. So before she decides to opt-out, it would definitely be in her interest to actually go online and see what she might be eligible for. I always think young invincible sort of sounds more like a rock band than a group of uninsured people. But, you know...

MARTIN: What's a better phrase? Young needing to get online and find out more?

GOLD: Sure.

MARTIN: That's not really catchy.

GOLD: Doesn't have the same ring to it. But, you know, 15 percent of young people have chronic conditions like asthma and diabetes. It's not like just because you're young you're healthy. Also, young people are most likely to go to the emergency room with some sort of injury related accident. You never know when that's going to happen. So, you know, that sort of invincible idea, whether it's real - the feeling is real or not, is a little bit of a misconception.

MARTIN: Jenny Gold is a correspondent at Kaiser Health News. She was kind enough to join us in our Washington, D.C. studios. Jenny Gold, thanks so much for keeping us up to date.